NPIMap

Individual provider Active NPI

Stacie Teresa McCally, FNP

  • Family Nurse Practitioner
  • Broomfield, CO
National Provider Identifier
1679183172
Registry record updated Aug 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0995946-NP Issued in CO
Practice address
12167 Sheridan Blvd
Broomfield, CO 80020-2417
Phone
(303) 658-9807
NPI assigned
Aug 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F05200856 CA
Family Nurse Practitioner 363LF0000X APN.0995946-NP CO Primary

Addresses

Primary practice location

12167 Sheridan Blvd
Broomfield, CO 80020-2417

Mailing address

12167 Sheridan Blvd
Broomfield, CO 80020-2417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210423000448 CO Practitioner - Nurse Practitioner 9032527486 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Medical Center, PCGroup PAC ID 4183536204, 86 clinicians

Practice addresses (Care Compare)

2750 Broadway St
Boulder, CO 80304-3573
Phone (303) 440-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F05200856CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Medical Center, P.C. CurrentSince Nov 7, 2022 Accepting new patients
Boulder Medical Center, P.C. CurrentSince Nov 7, 2022 Accepting new patients
The Little Clinic of Colorado, LLC Family CurrentSince Apr 1, 2021 Accepting new patients

Locations

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

12167 Sheridan Blvd
Broomfield, CO 80020
Phone (303) 439-0169

19711 E Smoky Hill Rd
Centennial, CO 80015
Phone (303) 400-5204

7984 W Alameda Ave
Lakewood, CO 80226
Phone (303) 459-7105

2620 Elm Hill Pike
Nashville, TN 37214
Phone (615) 425-4211

Interoperability endpoints

  • Direct secure messaging: stacie.mccally@krogerhealth.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628899200000",
    "number": "1679183172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12167 SHERIDAN BLVD",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12167 SHERIDAN BLVD",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202417",
            "telephone_number": "303-658-9807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLY",
        "first_name": "STACIE",
        "middle_name": "TERESA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-09",
        "last_updated": "2021-08-14",
        "certification_date": "2021-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "F05200856",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0995946-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

Verify at the official NPI Registry.